Eugene, OR–All surgeons, no matter how experienced, encounter tough cases that require creative approaches.
Richard Hoffman, MD, described such a patient with a 2+ nuclear sclerotic cataract that he removed using a standard bimanual technique, which progressed routinely.
Dr. Hoffman used a horizontal chopping technique to remove the nucleus and filled the capsular bag with a cohesive viscoelastic (OVD). The anterior capsulorhexis and posterior capsule were intact.
Dr. Hoffman, clinical associate professor of ophthalmology, Oregon Health & Science University, Eugene, OR, injected a single-piece hydrophobic acrylic IOL into the bag. The haptics were covered with polymethylmethacrylate mittens to prevent them form sticking to the optic.
During the centering of the IOL, a crease in the posterior capsule was visible. Dr. Hoffman hypothesized that it was a zonular dialysis with a wrinkled bag that might resolve with gentle pushing down on the IOL. Repeated pushing did not reach the desired end.
Since the lens was centered, Dr. Hoffman started to remove the OVD. In doing so, the IOL began to shimmy and vitreous was visible in the aspirating cannula. The IOL appeared slightly tilted and moved down toward what Dr. Hoffman described as an obvious opening in the equator of the bag.